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Slipped capital femoral epiphysis (SCFE) is a relatively common hip disorder often seen in overweight, peripubertal children. Although the exact etiology is uncertain, it is generally accepted that underlying endocrinopathies play a role in the pathogenesis. Hypothyroidism is the endocrine disorder cited most commonly in association with SCFE, and patients often have no history of thyroid dysfunction at the time of presentation. Despite being a well-recognized risk factor, recommendations for screening thyroid function in patients with typical presentations of SCFE have not been deemed cost-effective; however, there is data to support screening for hypothyroidism in patients with atypical presentations of SCFE or short stature. Hypothyroidism may have a significant impact on healing and bone union after surgical management of SCFE and there is a paucity of case reports in the literature describing potential peri- and postoperative complications. We performed a systematic review of the literature of all reported cases of SCFE with associated hypothyroidism using the search terms, which demonstrated a physiologic relationship between hypothyroidism and SCFE. Two case reports of SCFE in patients with hypothyroidism and associated complications are presented with the literature review. There is a physiologic relationship between thyroid dysfunction and SCFE, and we postulate that profound hypothyroidism may contribute to delayed healing or nonunion in patients undergoing operative management. We support the recommendation to screen patients with short stature, atypical presentation of SCFE, or perisistent nonunion after surgery. In cases of hypothyroidism, we recommend thyroid hormone replacement and laboratory confirmation of return to euthyroid state prior to operative intervention.

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Key points• Correction of pelvic obliquity in neuromuscular scoliosis is a surgical challenge.• There are numerous instrumentation techniques to achieve spinopelvic fixation in these patients.• The MW construct may be a superior instrumentation technique for the correction of pelvic obliquity and Cobb angles in neuromuscular scoliosis. Mini AbstractThe MW construct is a newly described means of achieving spinopelvic fixation in neuromuscular scoliosis. It has been theorized that this construct may provide for superior correction of pelvic obliquity in neuromuscular patients. Our study retrospectively examines this theory by comparing the results of posterior spinal fusion using the new MW technique to matched controls undergoing surgery utilizing the Galveston construct.

Lawnmower injuries in children often present treatment challenges due to complex soft tissue damage. Vacuum-assisted closure (VAC), the application of controlled subatmospheric pressure to a wound surface, has been used to treat complex lacerations in many patients and has been shown to be safe and effective in children. However, VAC treatment of lawnmower injuries in children has not been reported. This study analyzes the outcomes of treatment following the use of VAC in children with lawnmower injuries and compares the results of VAC treatment to historical controls who were treated before VAC was available for wound treatment. The use of VAC demonstrated a trend toward a decrease in revision amputations and an improvement in function after treatment. There were no complications or adverse reactions related to VAC treatment. The VAC system is a safe and effective method of treating soft tissue injuries resulting from lawnmower accidents in children.